Story at-a-glance -

Chronic kidney disease is claiming the lives of many young workers on sugar plantations in Central America; though the cause remains a mystery, exposure to agricultural chemicals, fructose and dehydration from the labor-intensive work are the front-running theories

Severe dehydration can activate the polyol pathway that will convert glucose to fructose, which is then metabolized by a “killer” enzyme called fructokinase, which may cause kidney disease and damage

The rate of chronic kidney disease in Nicaragua is 10 times higher than in the U.S.

World Bank, which has issued more than $100 million in loans to Nicaragua’s sugar industry, is funding an investigation to search for causes of the long-term epidemic of chronic kidney disease in Nicaragua

What Mystery Disease is Killing Thousands in Central America?

February 29, 2012|82,235views

The United States imports one-fourth of its raw sugar from Central America, a region known as much for its sandy beaches and lush rainforests as its many acres of sugar plantations.

In Central American countries like Nicaragua, finding employment is a challenge, and many residents begin working in the sugar fields when they are still children, as young as 10 years old.

It's labor-intensive work, requiring long hours of manual labor under hot sun and high temperatures, often with few or no breaks in between.

Now, chronic kidney disease is claiming the lives of many of these young workers -- to the extent that some are labeling the condition "Sugar Cane Kidney Disease" -- and researchers are scrambling to uncover the cause as the death toll steadily rises.

"The Island of the Widows"

In the United States, chronic kidney disease is typically caused by diabetes and high blood pressure, conditions that are generally not impacting the young victims in Central America.

Still, the rate of chronic kidney disease in Nicaragua is 10 times higher than in the U.S.

Furthermore, while the condition is considered treatable if detected early, in rural Central America access to medical care such as dialysis or kidney transplants is limited, and so the kidney disease advances quickly and is almost always fatal.

Daniel Brooks, a professor of epidemiology at Boston University School of Public Health, who has been investigating the mystery, told Fox News Latino:i

"Once someone gets it, it's basically a death sentence."

According to an analysis of health data by the International Consortium of Investigative Journalists, more than 2,800 men have died from kidney failure in Central America each year from 2005-2009. As iWatch News reported:ii

"In El Salvador and Nicaragua alone over the last two decades, the number of men dying from kidney disease has risen fivefold. Now more men are dying from the ailment than from HIV/AIDS, diabetes and leukemia combined.

… The surge of kidney disease is overwhelming hospitals, depleting health budgets, and leaving a trail of widows and children in rural communities. In El Salvador, CKD is the second leading cause of death for men. In the province of Guanacaste, Costa Rica, the regional hospital had to start a home dialysis program because it was overwhelmed with so many CKD victims that it began running out of beds to treat patients with other ailments. So many men have died in some parts of rural Nicaragua that … [one] community, called The Island, now is known as the Island of the Widows — La Isla de las Viudas."

Why are so Many Young Men Dying from Chronic Kidney Disease in Central America? This is the burning question and also the heart of the mystery, because no one knows for sure. There are several plausible theories, though. In a report by Brooks and colleagues, which reviewed 22 epidemiological studies looking into hypotheses about potential causes of chronic kidney disease in Nicaragua, it's stated:iii

To date, no one cause has emerged as a concrete explanation, but the two theories receiving the most attention are exposure to agricultural chemicals and repeated bouts of dehydration. The sugar plantation workers are exposed to toxic pesticides on a daily basis, and it's known that even the so-called inert ingredients in certain pesticides may cause kidney failure.iv Dehydration, also linked to kidney disease, is also a major concern, especially amidst reports that the workers may be subjected to poor working conditions. As ABC News reported:

"Nicaragua's highest rates of chronic kidney disease show up around the Ingenio San Antonio, a plant owned by the Pellas Group conglomerate, whose sugar mill processes nearly half the nation's sugar.

… According to one of Brooks' studies, about eight years ago the factory started providing electrolyte solution and protein cookies to workers who previously brought their own water to work. But the study also found that some workers were cutting sugar cane for as long as 9 1/2 hours a day with virtually no break and little shade in average temperatures of 30 C (87 F).

In 2006, the plantation, owned by one of the country's richest families, received $36.5 million in loans from the International Finance Corp., the private-sector arm of the World Bank Group, to buy more land, expand its processing plant and produce more sugar for consumers and ethanol production."

Why Fructose Combined with Dehydration May be the Deadly Hidden Culprit

Fructose metabolism is quite different from glucose (dextrose) metabolism in that it places the entire burden on your liver, and this accounts for many of its devastating health effects. However, it appears that the Central American workers may be engaging in the "perfect storm" of activities for fructose to cause devastating damage to their kidneys.

As explained by Dr. Richard Johnson, chief of the division of kidney disease and hypertension at the University of Colorado, in his upcoming book The Fat Switch, this mystery illness likely starts with dehydration and is then made worse by the fact that many workers drink sugar-sweetened pineapple or mango juice or soft drinks (all high in fructose) to rehydrate.

Let me explain ...

When you consume fructose, some of it is filtered in your kidneys and taken up into your tubules. Indeed, studies have linked soft drinks and high-fructose diets with kidney disease and accelerated kidney damage. But there is another, even more sinister, effect that appears to be harming young men working in the sugar cane fields.

Your body is capable of converting glucose into fructose via a mechanism known as the polyol pathway. This is especially common among people with diabetes or those who are severely insulin resistant, but the polyol pathway is also activated by dehydration.

So as the Central American workers become dehydrated, the polyol pathway is activated in their kidney tubules, converting glucose to fructose. Meanwhile, the workers take in even more fructose in the form of fruit juice and soda during their workday. This leads to a massive increase in fructose that is, in turn, metabolized by a "killer" enzyme known as fructinase C. This enzyme actually leads to energy loss in the cell and is thought to play a role in numerous diseases, including kidney disease and injury.

Dr. Johnson explains:

" ... when fructose is metabolized by fructokinase, the fructose is so rapidly metabolized that there is an initial loss of energy in the cell before energy is produced ... Fructokinase is like a run-away train, or a speeding truck coming down the mountain that is out of control. The degree of cell shock induced by fructokinase will relate to the amount of fructose it sees and the level of fructokinase present in the cell. ... Sugar Cane Kidney Disease may be another disease of fructokinase. Severe dehydration can activate the polyol pathway that will convert glucose to fructose and provide ammunition for fructokinase to cause injury to the tubules."

Are the Central American Workers Just More Victims of the Sugar Industry?

Interestingly, World Bank, which has issued more than $100 million in loans to Nicaragua's sugar industry,v is funding the Boston University project, with Brooks as the principal investigator, to search for causes of the long-term epidemic of chronic kidney disease in Nicaragua. Nicaragua Sugar Estates Limited, the largest employer in the area and owner of many of the plantations where the illnesses are occurring, denies any connection to the epidemic, which isn't surprising.

The sugar industry is a shrewd, savvy, well-oiled machine that is also denying any connection between their product and the obesity and diabetes epidemics going on in the industrialized world. They also have access to immense power and give generously to both political parties in the United States to ensure that their products are protected.

While sugar consumption continues to contribute to premature deaths in the developed world in the form of an untold number of cases of cancer, heart disease, high blood pressure, diabetes and other chronic diseases, the Central American workers on the sugar plantations may be victims in another sense, succumbing to kidney disease from years of hard labor, dehydration, and fructose ingestion -- or a mix of these and other factors combined.

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